Antibiotic Stewardship

What is Antibiotic Stewardship?

 

Antibiotic stewardship involves coordinated efforts to ensure antibiotics are prescribed and used appropriately, minimizing adverse effects and combating resistance. These initiatives are vital to preserving antibiotic efficacy for the future by preventing unnecessary or incorrect use.

Why is Antibiotic Stewardship Important?

 

Preventing the unnecessary or incorrect use of antibiotics through antibiotic stewardship protocols is important because this

  • reduces the risk of infections becoming harder or impossible to treat
  • reduces exposure, lowering the risk of adverse effects from these medications
  • reduces costs associated with unnecessary prescriptions
  • preserves the effectiveness of existing antibiotics for future generations

How Do We Measure Improvement/Compliance?

 

Health Partners Plans/Jefferson Health Plans uses NCQA antibiotic stewardship HEDIS measures to support safer, evidence-based prescribing and help prevent resistance and adverse drug events.

Appropriate Treatment for Upper Respiratory Infection (URI): The percentage of episodes for persons 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic dispensing event.

Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB): The percentage of episodes for persons 3 months of age and older with a diagnosis of acute bronchitis/bronchiolitis that did not result in an antibiotic dispensing event.

Appropriate Testing for Pharyngitis (CWP): The percentage of episodes for persons 3 years and older where the person was diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode. 

Antibiotic Utilization for Respiratory Conditions (AXR): The percentage of episodes for persons 3 months of age and older with a diagnosis of a respiratory condition that resulted in an antibiotic dispensing event.

What Steps Can I Take to Make a Difference?

 

Contact the Provider Services Helpline at 1-888-991-9023 (Monday – Friday, 9 a.m. – 4:30 p.m.) to learn how your practice is performing in each antibiotic stewardship HEDIS measures.

Utilize the Agency for Healthcare Research and Quality’s (AHRQ) antibiotic stewardship toolkit featuring the Four Moments of Antibiotic Decision Making. Choose your care setting and apply these principles when considering antibiotics:

Acute Care Hospital
  • Does my patient have an infection that requires antibiotics?
  • Have I ordered appropriate cultures before starting antibiotics? What empiric therapy should I initiate?
  • A day or more has passed. Can I stop antibiotics? Can I narrow therapy or change from IV to oral therapy?
  • What duration of antibiotic therapy is needed for my patient's diagnosis?

 

(Source: (https://www.ahrq.gov/antibiotic-use/acute-care/four-moments/index.html)

Ambulatory Care
  • Does my patient have an infection that requires antibiotics?
  • Do I need to order any diagnostic tests?
  • If antibiotics are indicated, what is the narrowest, safest and shortest regimen I can prescribe?
  • Does the patient understand what to expect and the follow-up plan?

 

(Source: https://www.ahrq.gov/antibiotic-use/ambulatory-care/four-moments/index.html)

Long-Term Care
  • Does the resident have symptoms that suggest an infection?
  • What type of infection is it? Have we collected appropriate cultures before starting antibiotics? What empiric therapy should be initiated?
  • What duration of antibiotic therapy is needed for the resident's diagnosis?
  • It's been 2-3 days since antibiotics were started. Reevaluate the resident and review results of diagnostic tests. Can we stop antibiotics? Can we narrow therapy? Can we change to oral antibiotics?

(Source: https://www.ahrq.gov/antibiotic-use/long-term-care/four-moments/index.html)

Where Can I Find Additional Information on Antibiotic Stewardship?

 

The following additional resources are available to support providers in practicing antibiotic stewardship: